Provider Demographics
NPI:1699560151
Name:MIORA
Entity type:Organization
Organization Name:MIORA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ARIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOVER JANICEK
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:866-770-1588
Mailing Address - Street 1:1618 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3711
Mailing Address - Country:US
Mailing Address - Phone:855-430-5433
Mailing Address - Fax:
Practice Address - Street 1:1618 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3711
Practice Address - Country:US
Practice Address - Phone:855-430-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFETIME FITNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty